Tag: Injury

A new study found that 47% of injured workers with chronic opioid use weaned off the painkillers completely within 24 months and that those who did not wean reduced their opioid dosage by an average of 52%, the Workers Compensation Insurance Rating Bureau of California announced Thursday.
The Oakland, California-based ratings agency studied its databases of medical transaction records and unit statistical reports since July 2012 to examine the cost implications of chronic opioid use and the process of weaning injured workers off opioids statewide.
The study also found that claims involving chronic opioid use cost more than nine times in physician services than the average workers comp claim and that the median time from chronic opioid use to weaning completely was eight months.
Meanwhile, the median time from accident date to when the worker was weaned off completely was 19 months.
The study also examined types of injuries treated, finding that “over 80% of transactions associated with chronic opioid claimants had primary diagnoses of soft tissue injuries.
Injured workers who weaned off were more likely to have Nature of Injury codes for Fractures, and less likely to have Unspecified Injuries than those who did not wean off.”

The number of opioid-dependent injured workers under treatment in the Ohio Bureau of Workers’ Compensation system fell 19% in 2017, the sixth consecutive year the numbers have fallen under the bureau’s efforts to reduce opioid patients, regulators announced Thursday.
The number of injured workers who met or exceeded the threshold of being clinically dependent on opioids fell to 3,315 at the end of fiscal year 2017, a 59% decrease since 2011, the bureau said in a statement.
Total drug costs also fell to $86 million in 2017, $47 million less than in 2011.
The figure amounts to $24 million less on opioids since 2011.
“That means we have 4,714 fewer injured workers at risk for opioid addiction, overdose and death than we had in 2011,” the bureau’s pharmacy director, Nick Trego, told the board’s Medical Services and Safety committee Thursday, according to the statement.
“These falling numbers are the direct result of our efforts to improve our protocols, more closely monitor our opioid population and encourage best practices from our prescribers.” Mr. Trego also credited “the growing awareness of the opioid epidemic and efforts by the health care community, government and others to do something about it,” according to the statement.
The bureau expects the opioid numbers to continue to fall as prescription protocols evolve and alternative pain therapies emerge, according to the statement.
“Weaning a dependent person off opioids, or at least to safer levels, is a long, deliberate process requiring cooperation from the injured worker, health care providers and the worker’s support network,” Mr. Trego told the board, according to the statement.
“We’re just one part of that equation, but we’re committed to it.”

A Pennsylvania appeals court ruled Thursday in favor of a US Airways flight attendant who claimed her slip and fall on a shuttle bus transporting her between a Philadelphia International Airport terminal and an employee parking lot was work-related.
On Jan. 23, 2015, flight attendant Kimberly Anne Zabroski was trying to place her luggage on the racks on a shuttle bus after parking in a city-owned lot.
On the bus, she stepped in water on the floor, causing her right foot to slide out from underneath her.
Her left knee buckled, causing her to fall backwards, crushing her left foot under her.
She also felt something rip in her left foot and needed assistance getting to a seat, according to court documents in US Airways Inc. v. Workers’ Compensation Appeal Board.
A three-judge Commonwealth Court panel unanimously rejected arguments posed by US Airways that the incident did not take place on the airline’s property and that the shuttlebus was part of Ms. Zabroski’s commute to work, according to court documents.
The airline argued that it also did not own the shuttle bus and did not require employees to park in the lot.
It asked that the appeals court review a Workers’ Compensation Appeals Board order from April 2016 that Ms. Zabrosksi “sustained injuries in the course and scope of her employment,” documents state.
The ruling found that her commute ended at the parking lot and work began on the shuttle: “As part of doing business with the airport, Employer understood that the airport would transport Employer’s employees who drove to work.
Thus, Employer also understood that, in order to arrive at their work area to start their shift, employees who drive to work invariably board the shuttle bus after their commute to the airport.”

A Siloam Springs, Arkansas, firefighter who suffered a foot fracture after he was startled by a nightmare that spiders were crawling all over him is not eligible for workers compensation, the Arkansas Court of Appeals in Little Rock, Arkansas, ruled Wednesday.
Shawn Seth Hansen appealed a decision of the Arkansas Workers Compensation Commission, which affirmed and adopted an earlier decision of an administrative law judge that found Hansen had failed to prove he sustained a compensable injury to his left foot, according to court documents.
In 2015, Mr. Hansen was employed by the City of Siloam Springs, where as a firefighter and an emergency medical technician he worked 24-hour shifts.
During his shift, he was required to stay on site unless he was performing a work-related function or errand.
The firehouse provided him with sleeping accommodations and encouraged him to sleep at night, according to court records.
During a 24-hour shift on Nov. 5, 2015, Mr. Hansen awoke from a bad dream in the middle of the night “in which he believed spiders were crawling on him.
In his sleepy stupor, he jumped from his bed and injured his foot, suffering a fracture of his left fifth metatarsal.
He ultimately required surgery for his injury,” records state.
In the latest ruling in Shawn Seth Hansen v. City of Siloam Springs and Arkansas Municipal League, Mr. Hansen’s injury was found to be “idiopathic.” “Because an idiopathic injury is not related to employment, it is generally not compensable unless conditions related to the employment contribute to the risk,” the ruling states.

So they circumvent the system … and get caught.” “It might be easier to tell you what I haven’t seen,” said Thomas Martin, president and lead investigator with Newport Beach, California-based Martin Investigative Services, which helps insurers and employers investigate fraud — a steadily increasing stream of business.
Mr. Martin estimates that upwards of 25% of workers comp claims have some element of fraud involved.
“It’s like a feeding frenzy.” Mr. Fodor has a word for what is increasingly helping insurers and employers tackle the workers comp fraud problem: technology.
Meanwhile, exaggerated or fake injuries are now easier to uncover, experts say.
Sometimes it’s traditional video surveillance while other times it’s a claimant’s social media activity that tips off investigators, said Steve Cassell, Lake Mary, Florida-based president and CEO of Command Investigations L.L.C.
“(Social media) is an addiction; people can’t put their phones down,” said Mr. Cassell, adding that roughly 80% of adults use one or several social media platforms.
“It’s all public information.” In many instances, social media gives investigators the tip they need to know that video surveillance — which is more likely to be admissible in court because of the time stamp — might be necessary, said Mr. Cassell, adding that photos posted of an injured worker engaged in an activity could have been taken pre-injury.
: workplace injury.
Aside from faking the severity of an injury, experts say real injuries that were incurred outside of the workplace are finding their way into the comp world.
Here, surveillance also helps, said Mr. Marasco.

Injuries sustained in suicide attempt are compensable: Court.
He filed a workers compensation claim under the Longshore and Harbor Workers’ Compensation Act with Leeward’s insurer, Hawaii Employers’ Mutual Insurance Co. Inc., according to court records.
In 2003, Mr. Kealoha shot himself in the head, causing severe head injuries, in a suicide attempt that he said was a result of his fall and litigation over that claim.
A psychiatrist who testified on his behalf during his first hearing in front of an administrative law judge said Mr. Kealoha suffered from major depressive disorder due to multiple traumas and chronic pain from the fall and stress from the litigation, which caused depression, anger and anxiety, and worsened his already poor impulse control, court records show.
The U.S. Department of Labor’s Benefits Review Board reversed the judge’s decision and recognized an exception to that provision, saying a worker’s suicide attempt resulting from “irresistible impulse” caused by a work-related injury is not “willful” and therefore is compensable, according to court documents.
Circuit Court of Appeals again remanded the case, saying evidence of planning a suicide attempt does not preclude compensability, court records show.
The judge awarded benefits to Mr. Kealoha under the Longshore Act, and the Benefits Review Board affirmed the decision.
Leeward Marine and its insurer appealed the decision to the 9th U.S.
In an unpublished decision issued Wednesday, a three-judge panel of the appeals court ruled that the board correctly affirmed the administrative law judge’s decision to award benefits to Mr. Kealoha and denied the motion to review, saying recovery under the Longshore Act is appropriate.
The case is Leeward Marine Inc.; Hawai’i Employers’ Mutual Insurance Co. v. Director, Office of Workers’ Compensation Program; William B. Kealoha.

Up to 18% of injured workers not returning to work after one year.
The Cambridge, Massachusetts-based institute released its latest batch of reports tackling data in six new states – Indiana, Massachusetts, Michigan, North Carolina, Virginia, and Wisconsin –and found that recovery of physical health and functioning for injured workers was similar across the 15 states researched over the last few years.
Researchers examined physical health and functioning data for injured workers, return to work figures, earnings recovery, access to and satisfaction with medical care to cull data, according to a press statement.
“By examining outcomes of injured workers, policymakers and other stakeholders can better understand how different state workers’ compensation systems compare in order to identify and prioritize opportunities to improve system performance,” said Ramona Tanabe, WCRI’s executive vice president and in-house counsel, in a press statement.
Among the latest findings: Indiana: 10% of workers with more than seven days of lost time reported never returning to work for at least a one-month period predominantly due to the injury; 11% reported no substantial return to work within one year of the injury.
Virginia: 14% percent of workers with more than seven days of lost time reported never returning to work for at least a one-month period predominantly due to the injury; 17% reported no substantial return to work within one year of the injury.
Wisconsin: 12% of workers with more than seven days of lost time reported never returning to work for at least a one-month period predominantly due to the injury; 13% reported no substantial return to work within one year of the injury.
Massachusetts: 15% of workers with more than seven days of lost time reported never returning to work for at least a one-month period predominantly due to the injury; 17% reported no substantial return to work within one year of the injury.
North Carolina: 14% of workers with more than seven days of lost time reported never returning to work for at least a one-month period predominantly due to the injury; 18% reported no substantial return to work within one year of the injury.
Michigan: 12% of workers with more than seven days of lost time reported never returning to work for at least a one-month period predominantly due to the injury; 16% reported no substantial return to work within one year of the injury.

Workplace altercations that result in an injury can sometimes lead to complicated questions about whether the employee’s own actions preclude him or her from recovering workers compensation benefits.
Mr. Washington allegedly called passenger Lamar Rogers, also a Gallo employee, a “homosexual” and spoke threateningly to him, according to court documents in Washington v. Gallo Mechanical Contractors L.L.C.
Louisiana’s workers comp statute specifies that no compensation shall be allowed for an injury caused “to the initial physical aggressor in an unprovoked physical altercation, unless excessive force was used in retaliation against the initial aggressor.” In February 2016, Gallo and Creative Risk filed a motion for summary judgment seeking a dismissal of the claim, which was granted by an Office of Workers’ Compensation judge.
Mr. Washington appealed the decision to the Louisiana Court of Appeal for the 4th Circuit in New Orleans, saying he was on the clock and being compensated for his work at the time of the altercation, and that he was seated in the driver’s seat of the shuttle when he was struck from behind by Mr. Rogers, court records show.
Mr. Washington said it was “indisputable” that his injury occurred while he was in the course of his employment, according to court documents.
Gallo and Creative Risk did not dispute that Mr. Washington was seated in the driver’s seat of the shuttle when the incident occurred nor that both men were working for Gallo at the time of the incident.
Like Louisiana, California precludes aggressors in workplace altercations from recovering workers comp benefits.
when two employees engaged in horseplay that evolved into an altercation.
You are intentionally engaging in misconduct that you otherwise know is unsafe.” Mr. Randall said these cases can be complicated because they frequently involve an escalation from verbal to physical contact.
Because altercations can lead to a variety of gray areas and complicated issues in workers comp claims, employers should be aware of the initial aggressor defense in cases of workplace altercations, said Mr. Randall.

Reprints Kristen Beckman A high school teacher injured while breaking up a fight between students may not sue the school district where he worked for negligence because workers compensation was his exclusive remedy, a federal court ruled Thursday.
Among his responsibilities as a lunchroom supervisor were monitoring students, maintaining order and intervening to break up fights if he could do so safely.
In March 2016, Mr. Ekblad sued the school district, alleging negligence and negligent supervision because the district failed to protect him despite being aware of safety concerns at the school.
The court noted there are three exceptions to Minnesota’s workers comp exclusive remedy provision, including an assault exception, an intentional act exception and a co-employee liability exception.
“Ekblad has failed to establish that any of these exceptions apply in this case,” District Judge David S. Doty said in his ruling.
The assault exception covers injuries inflicted for personal reasons.
The intentional act exception precludes workers comp coverage when the employer acted in such a way as to intend to inflict injury on an employee.
Mr. Ekblad argued that the district’s policies regarding student discipline and school safety were misguided, not followed or both, which led to his injuries.
The court found that even if the district’s policies were substandard or ineffective, that did not establish a conscious and deliberate intent to inflict injury.
Mr. Ekblad argued that the district superintendent and assistant superintendent were obligated to maintain a safe workplace.

Source: Business Insurance Reprints Kristen Beckman An employer has the right to direct medical treatment of an injured worker after a subsequent diagnosis secured independently by the employee revealed a work-related injury that was previously deemed not compensable, an Oklahoma appeals court has ruled. Edward Bray, an employee of Houston-based […]

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